Life Expectancy in Frail Individuals
Frail older adults have a life expectancy of less than 1 year remaining, with severely frail individuals (Clinical Frailty Scale 7-8) approaching end-of-life and unable to recover even from minor illness. 1
Frailty-Specific Life Expectancy Estimates
Severely Frail (CFS 7)
- Completely dependent for personal care but appear stable with life expectancy typically not at high risk of dying within 6 months 1
- However, deprescribing guidelines specifically categorize these patients as having less than 1 year of life remaining 1
Very Severely Frail (CFS 8)
- Completely dependent and approaching end of life 1
- Could not recover even from a minor illness, indicating imminent mortality risk 1
Terminally Ill (CFS 9)
- Life expectancy less than 6 months who are not otherwise evidently frail 1
Mortality Risk by Frailty Severity
Mild to Moderate Frailty (CFS 5-6)
- Within first 5 years, prefrail and frail participants show more than doubled mortality risk compared to robust individuals (HR 2.08-2.69) 2
- Frail individuals without multimorbidity still demonstrate 63% mortality over 15 years compared to 19% in robust peers 2
Quantified Risk Using Frailty Index
- Each 0.1 increment in frailty index (representing 10% more accumulated deficits) measurably increases hazard ratios for both cardiovascular and non-cardiovascular mortality 3
- Mortality becomes high when frailty index score approaches 0.7 1
Short-Term Mortality Predictors
Within 3-4 Years
- Frailty phenotype (≥3 of 5 Fried criteria) independently predicts mortality with hazard ratios 1.82-4.46 unadjusted and 1.29-2.24 adjusted for health, disease, and social characteristics 4
- Intermediate frailty (1-2 criteria) shows intermediate risk with odds ratio 4.51 for progressing to frailty 4
Within 8 Years
- FRAIL scale shows 41.2% mortality among frail individuals 5
- Frailty phenotype shows 44.9% mortality 5
- Frailty Index shows 27.0% mortality 5
- Clinical Frailty Scale shows 25.3% mortality 5
Critical Clinical Context
A common pitfall is assuming all "frail" labels indicate the same prognosis—the degree of frailty matters enormously. 1 Mildly frail individuals (CFS 5) who need help with finances and heavy housework have dramatically different life expectancy than severely frail individuals (CFS 7-8) who are completely dependent. 1
Frailty is potentially reversible through interventions targeting physical activity, nutrition, and deficit accumulation, meaning the trajectory is not fixed. 6 Frailty states are dynamic and bidirectional—individuals can transition between robust, prefrail, and frail states over time. 6
For medication management decisions, guidelines specifically reference frail older adults with less than 1 year of life remaining when making deprescribing recommendations, establishing this as the operational definition for severe frailty in clinical practice. 1